Thursday, May 3, 2018

The number of children identified with autism has more than doubled
over the last decade. The dramatic increase in prevalence, together with
the clear benefits of early intervention, have created a pressing need for
schools to identify children who may have an autism spectrum disorder (ASD). As
a result, specialized support personnel such as school psychologists are now being asked to participate in the
screening, assessment, and educational planning for children and youth on the
autism spectrum more than at any other time in the recent past. Moreover, the
call for greater use of evidence-based practice has increased demands that
professionals be prepared to recognize the presence of risk factors, engage in
case finding, and be knowledgeable about evidence-based assessment (EBA) and
intervention practices for ASD.

Evidence
Based Practice

The challenge to improve the services to children with ASD in
our schools is dependent on the adoption of evidence-based practices in
diagnosis/identification, assessment, and intervention. The scientific
literature identifies two primary elements of evidence-based practice: (a) intervention
that includes, but is not limited to, those treatment programs for which
randomized controlled trials have shown empirical support for the target
population and (b) assessment that guides identification/diagnosis,
intervention planning, and outcome evaluation. Evidence-based assessment (EBA) emphasizes the use of research and
theory to inform the selection of assessment targets, the methods and
measures used in the assessment, and the assessment process itself. Elements
of EBA in ASD include the following: (a) the use of psychometrically sound
assessments; (b) a developmental perspective that characterizes abilities over
the lifespan; (c) assessment of core areas of impairment associated with ASD;
and (d) the use of information from multiple sources, including direct and
indirect observation from parents and teachers.

Unfortunately, current research suggests that EBA practices
are not implemented in our schools with consistency. For example, a recent
nationwide survey of school psychologists’ knowledge of and training and
experience with ASD on assessment practices found that less than 25% engaged in
EBA (Aiello, Ruble, & Esler, 2017). Most school psychologists reported that they did not engage in comprehensive
assessment of ASD, which was defined as assessments that consider all areas of
development in addition to the use of psychometrically sound ASD-specific
instruments. Even among school psychologists who implemented EBA, the majority
relied on ASD checklists that provide limited information and, in the case of
the GARS-2, have weak psychometric properties (Aiello et. al., 2017; Norris & Lecavalier, 2010;
Wilkinson, 2016). These results indicate a significant gap between best and
current practices and the need for guidance
regarding which tools demonstrate the strongest psychometric properties for
identifying students with ASD.

Psychometric
Properties

It is
imperative that school psychologists have an understanding of the basic psychometric
properties that underlie test use and development when assessing children and
youth for ASD. For example, sensitivity and specificity areespecially important psychometric characteristics to consider when evaluating
the quality and usefulness of tests and rating scales. Sensitivityand specificityare measures of a test's
ability to correctly identify someone as having a given disorder or not having
the disorder. Sensitivity refers to the percentage of cases
with a disorder that screen or test positive. A highly sensitive test means that there
are few false negative results (individuals with a disorder who screen
negative), and thus fewer cases of the disorder are missed. Specificityis
the percentage of cases without a disorder that screens negative. A highly
specific test means that there are few false positive results (e.g.,
individuals without a disorder who screen positive). False negatives decrease
sensitivity, whereas false positives decrease specificity. An efficient ASD-specific assessment tool should should have high sensitivity and minimize false negatives, as these are individuals with
a likely disorder who remain unidentified. Sensitivity and specificity levels
of .80 or higher are generally recommended.

Positive Predictive Value (PPV) and Negative Predictive Value (NPV) are also
important validity statistics that describe how well a screening tool or test
performs. The probability of having a given disorder, given the results of a
test, is called the predictive value. PPV is interpreted as
the percentage of all positive cases that truly have the disorder. PPV is
a critical measure of the performance of a diagnostic or screening measure, as
it reflects the probability that a positive test or screen identifies the
disorder for which the individual is being evaluated or screened. NPV is
the percentage of all cases screened negative that are truly without the
disorder. The higher the PPV and NPV values, the
more efficient the instrument at correctly identifying cases. It is important
to recognize that PPV is influenced by the sensitivity and
specificity of the test as well as the prevalence of the disorder
in the sample under study. For example, an ASD-specific measure may be expected
to have a higher PPV when utilized with a known group of
high-risk children who exhibit signs or symptoms of developmental delay, social
skills deficits, or language impairment. In fact, for any diagnostic test, when
the prevalence of the disorder is low, the positive PPV will
also be low, even using a test with high sensitivity and specificity.

Conclusion

All school psychologists should be
able to conduct psychoeducational assessments of students with ASD to determine
learning strengths and challenges, as well as to help determine special
education eligibility and develop Individualized Education Plan (IEP) goals and
objectives.Given that ASD is no longer considered a low incidence
disability, there is an urgent need for practitioners to be well
informed, trained, and skilled in the screening and assessment of ASD. Evidence-based assessment (EBA) requires using instruments with strong
reliability and validity for the accurate identification of children’s problems
and disorders, for ongoing monitoring of children’s response to interventions,
and for evaluation of treatment outcomes. We should select and utilize
assessments in a manner consistent with available evidence, choose tests that
have sound psychometric qualities, and rely on multiple measures to guide
high-stakes educational decisions.

American Educational Research Association, American
Psychological Association, & National Council on Measurement in Education.
(2014). Standards for educational and psychologicaltesting. Washington,
DC: American Educational Research Association.

American Psychological Association Statement Policy Statement
on Evidence-Based Practice in Psychology (2005). Retrieved on October 26, 2012
from

American Psychological Association Task Force on
Evidence-Based Practice for Children and Adolescents. (2008). Disseminating
evidence-based practice for children and adolescents: A systems approach to enhancing
care. Washington, DC: Author.

The study examined the longitudinal association between fathers’
early involvement in routine caregiving, literacy, play, and responsive
caregiving activities at 9 months and maternal depressive symptoms at
4 years. Data for 3,550 children and their biological parents were drawn
from the Early Childhood Longitudinal Study-Birth Cohort, including 50 children
with autism spectrum disorders and 650 children with other disabilities.
Information was collected on mothers' well-being and fathers' involvement in
several parenting activities: literacy; play; routine caregiving, such as
bathing; and responsive caregiving. Analyses examined whether the
association between father involvement and maternal depressive symptoms
differed for families of children with autism spectrum disorder (ASD) and for
families of children with other disabilities or delays from families of
children who were typically developing.

Results indicated that father literacy and responsive caregiving
involvement were associated with lower levels of depressive symptoms for
mothers of children with ASD.Mothers of children with
autism reported fewer depressive symptoms when their children were 4 years old
if the child's father engaged in literacy and responsive caregiving activities
such as comforting children when they were upset or taking the child
to the doctor when the child was 9 months old.

Fathers who read to their
children, or respond when the child cries, can give the mothers respite,
enabling mothers to perform other tasks or engage in self-care activities that
improve their mood and reduce stress, commented lead author Daniel J.
Laxman. "One of the key criteria of autism is difficulty with
communication, which may explain why these children's mothers are especially
susceptible to stress and depression," Laxman said. "It can be very
frustrating for parents -- and upsetting for children -- when children struggle
with communication. If fathers are reading to their kids, telling stories or
singing songs, it is going to be very beneficial for the child's development of
communication skills and learning words. By improving children's communication
skills, fathers' literacy activities may help alleviate some of the mothers'
concerns and stress related to these problems."

"Prior research and
work by early interventionists has focused solely on mothers' parenting of
their children with autism, reflecting societal expectations that fathers are
less involved, said co-author Brent A. McBride. "In family systems that
include children with autism, the stressors are huge, and mothers need all the
support they can grasp. Whether it comes from the child's father, their social
network or online resources, mothers need additional support to be able to
continue functioning in an effective way. We, as a society, have to ask men to
become involved, and it's very important that men fully understand the reasons
why their support and active engagement in parenting is so critical for the
family's functioning and for the child." Training and professional
development opportunities must be made available to early interventionists and
other professionals who work with families, so they can find ways to get
fathers more involved in parenting activities.

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